POS1088 CHALLENGES IN THE MANAGEMENT OF PSORIATIC ARTHRITIS IN LATIN AMERICA: A SYSTEMATIC REVIEW
Authors: A. Ribeiro, L. Dullius, N. Sartori, A. Azeredo-Da-Silva, O. Monticielo, C. Kohem, L. Coates, P. Palominos
Journal: Annals of the Rheumatic Diseases (2022)

Background In 2020, the International League of Associations for Rheumatology (ILAR) recommendations for management of psoriatic arthritis (PsA) were published. This aimed to adapt GRAPPA and EULAR recommendations to resource-poor settings. At that time, the paucity or absence of clinical studies endorsing the management of PsA patients in Latin America was remarked on by the international working group. Despite several challenges faced by patients and physicians in resource-poor countries, the literature on this theme is scarce. Objectives To recognize the main challenges on the management of PsA in Latin America described in recent publications. Methods A systematic literature review of clinical trials reporting at least one challenge/difficulty on the management of PsA in Latin America was conducted following PRISMA statements. References published in English, Spanish, French and Portuguese language and published in PubMed, Embase, and LILACS between 1980 and 2020 were included. The selection of references was conducted independently by two researchers in Rayyan QCRI program. Data were independently extracted by two reviewers. The Cochrane tool was used to assess the quality of studies. All challenges were noted and categorized into domains. Data analysis was descriptive. Results The search strategy resulted in 1505 references. Sixteen studies (15,145 PsA patients) were included in the final analysis: most were performed in Brazil (81.2%, N=13), recruited patients on biological therapy (75.0%, N=12) and were observational studies (87.5%, N=14). Difficulties faced by PsA patients and physicians in Latin America were the high incidence of opportunistic infections (described in 43.7% of publications, N=7), non-adherence to therapy (18.7%, N=3), discordance between patients and physicians regarding remission rates (18.7%, N=3), limited access to DMARDs (12.5%, N=2), issues related to the storage of biological drugs (12.5%, N=2), high impact of PsA on work and productivity (12.5%, N=2), elevated cost of biological drugs (12.5%, N=2), low drug persistence (6.2%, N=1), limited access to medical care (6.2%, N=1) and diagnostic delay (6.2%, N=1). Conclusion The challenges in the management of PsA in Latin America go beyond the care of opportunistic infections: special attention should be paid to logistical questions (e.g., correct medication storage, access to drugs and medical care) and educational problems (e.g., importance of adherence, patients understanding of disease and therapy) References [1]Elmamoun M, Eraso M, Anderson M, Maharaj A, Coates L, Chandran V; ILAR-PsA recommendations group, Abogamal A, Adebajo AO, Ajibade A, Ayanlowo O, Azevedo V, Bautista-Molano W, Carneiro S, Goldenstein-Schainberg C, Hernandez-Velasco F, Ima-Edomwonyi U, Lima A, Medina-Rosas J, Mody GM, Narang T, Ortega-Loayza AG, Ranza R, Sharma A, Toloza S, Vega-Espinoza L, Vega-Hinojosa O. International league of associations for rheumatology recommendations for the management of psoriatic arthritis in resource-poor settings. Clin Rheumatol. 2020 Jun;39(6):1839-1850. doi: 10.1007/s10067-020-04934-7. Epub 2020 Jan 16. PMID: 31950441; PMCID: PMC7237392. Disclosure of Interests None declared